Mental Health All-Hazards Disaster Planning Guidance

PART ONE - THE STATE OF THE STATES

States and Territories were asked for their existing plans to assess both the status of disaster mental health response planning and the best reference point for this publication. Thirty-one plans were submitted and analyzed, using a matrix similar to the one found in Appendix A of this document. Although it employed an admittedly high standard, the matrix provided a way to look at specific areas in the plans in which key content was included or missing. In general, the status of the disaster mental health plans submitted was both variable and incomplete.

Virtually all of the reviewed plans lacked key elements that a comprehensive and viable all-hazards plan should contain, and format and content varied among States. However, several plans had elements that were especially well done, and a few plans, while not in the all-hazards format, were comprehensive and creative.

It became clear in the development of this document that resources-both human and financial-are key elements to successful planning and implementation. Few States, however, have even a single person whose full-time responsibility is disaster and emergency mental health. Most States rely on leadership from a single person who devotes 5 percent to 50 percent of his or her time to this type of activity.

While funding for disaster mental health planning often is limited and must compete with other SMHA priorities, it was dramatic to see what could be accomplished in States with full-time staff and even small amounts of funding. The Massachusetts plan, for example, demonstrates what can be accomplished with an infusion of a relatively small amount of funding (provided by SAMHSA following the terrorist attacks of September 11, 2001). Another example of this is Texas, which has been able to accomplish a great deal by having full-time staff jointly funded by SEMA and SMHA.

Most States indicated they are in the process of plan revision. This interest in plan revision is primarily a result of a broad, renewed interest in disaster preparedness — sparked by the events of September 11, 2001 — and the recognition that existing plans often fall far short of being current and having maximum utility.

• Enhancing the use of a consistent planning template compliant with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO);
• Considering the use of the Incident Command System (ICS) because the SMHA must operate within the ICS to respond to a Federally declared emergency;
• Addressing regional disasters;
• Increasing attention to terrorism and bioterrorism;
• Enhancing training for SMHA staff in incident command;
• Addressing storage and maintenance of plans in multiple locations as well as in computer file format and notebook format;
• Expanding integration of regional mental health planning with regional and community emergency management;
• Addressing the evacuation of SMHA facilities and development of surge capacity in facilities;
• Revising long-standing CCP training to add or expand on the topics of terrorism, child and adolescent issues, multicultural components, and post-disaster substance abuse treatment and prevention needs;
• Expanding training to others (including SEMAs), and refining databases on specific and/or specialized skills existing within the State;
• Modifying State emergency plans to ensure mental health-related responsibilities are included under the SMHA and not (inappropriately) under other State agencies;
• Revising the State mental health plan to include more content on health, substance abuse, bioterrorism, the President's Homeland Security Advisory System, the State Department of Education, spiritual community involvement; racial and cultural competence; outreach to non-State organizations involved in disaster mental health; and State planning and advisory bodies; and
• Revising existing systems to include more standard forms and to incorporate biennial review and updating of the plan.

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